Yavuz Tolga Korkmaz

Impact of Dental and Zygomatic Implants on Stress Distribution in Maxillary Defects: A 3-Dimensional Finite Element Analysis Study

The aim of this study was to evaluate the stress distribution in the bone around dental and zygomatic implants for 4 different implant-supported obturator prostheses designs in a unilaterally maxillary defect using a 3-dimensional finite element stress analysis. A 3-dimensional finite element model of the human unilateral maxillary defect was constructed. Four different implant-supported obturator prostheses were modeled; model 1 with 2 zygomatic implants and 1 dental implant, model 2 with 2 zygomatic implants and 2 dental implants, model 3 with 2 zygomatic implants and 3 dental implants, and model 4 with 1 zygomatic implant and 3 dental implants. Bar attachments were used as superstructure. A 150-N vertical load was applied in 3 different ways, and von Mises stresses in the cortical bone around implants were evaluated. When the models (model 1-3) were compared in terms of number of implants, all of the models showed similar highest stress values under the first loading condition, and these values were less than under model 4 conditions. The highest stress values of models 1-4 under the first loading condition were 8.56, 8.59, 8.32, and 11.55 Mpa, respectively. The same trend was also observed under the other loading conditions. It may be concluded that the use of a zygomatic implant on the nondefective side decreased the highest stress values, and increasing the number of dental implants between the most distal and most mesial implants on the nondefective side did not decrease the highest stress values.

Does Laterally Rotated Flap Design Influence the Short-Term Periodontal Status of Second Molars and Postoperative Discomfort After Partially Impacted Third Molar Surgery?

PURPOSE To assess the influence of the surgical removal of partially impacted third molars (3Ms) and compare the effects of a 3-cornered laterally rotated flap (LRF) with primary closure (flap 1) and an envelope flap with secondary closure (flap 2) on the short-term periodontal status of the adjacent second molars (2Ms). We also assessed the postoperative complications after removal of the partially impacted 3M. MATERIALS AND METHODS A split mouth, randomized clinical study was designed. The study sample included patients with bilateral partially impacted 3Ms. The primary predictor variable was the type of flap design (flaps 1 and 2). The primary outcome variable was periodontal status (gingival recession [GR], probing depth [PD], plaque index [PI], and gingival index) of the 2Ms measured preoperatively and 90 days postoperatively. The secondary outcome variables were postoperative complications, including pain, facial swelling, alveolitis, and local wound infection. The other variables included gender, position of the 3Ms, and surgical difficulty. We performed descriptive, comparative, correlation, and multivariate analyses. RESULTS The sample included 28 patients aged 18 to 28 years. The GR, PD, and PI values with the flap 2 design were greater than those with the flap 1 design (P < .05). Facial swelling with the flap 1 design was significantly greater than with the flap 2 design on the second postoperative day (P < .05). The pain levels with the flap 1 design were significantly greater than those with the flap 2 design on the first and second postoperative days (P < .05). According to the multivariate regression analyses, flap design was closely related to the periodontal status of the 2Ms and postoperative discomfort. CONCLUSION The results of the present clinical study have shown that the flap design in partially impacted 3M surgery considerably influences the early periodontal health of the 2Ms and postoperative discomfort. However, although the 3-cornered LRF design might cause more pain and swelling, it could be the method of choice for partially impacted 3M surgery because of the early periodontal healing.

Does additional cone beam computed tomography decrease the risk of inferior alveolar nerve injury in high-risk cases undergoing third molar surgery?Does CBCT decrease the risk of IAN injury?

The objectives of this study were to evaluate the efficacy of additional cone beam computed tomography (CBCT) imaging on decreasing the risk of inferior alveolar nerve (IAN) injury during third molar removal in patients at high risk and to assess the surgical outcomes. The study sample included patients considered at high risk for IAN injury based on panoramic radiography (PAN) evaluation. The primary predictor was the type of imaging method (PAN only or with additional CBCT). The other variables were demographic and anatomical/radiographic factors. The primary outcome variable was IAN injury. The secondary outcome variables were the preoperative surgical plan and surgical results including IAN exposure and duration of surgery. The sample comprised 122 patients (139 teeth) aged 18-48 years. Postoperative temporary IAN injury was present in three (4.2%) cases in the CBCT group and 11 (16.4%) in the PAN group at 7 days after surgery. However, none of the patients had a permanent IAN injury at the 6-month follow-up. Additional CBCT imaging was not superior to PAN in reducing IAN injury after third molar surgery during long-term follow-up. Nonetheless, CBCT may decrease the prevalence of temporary IAN injury and improve the surgical outcomes in high-risk patients.

Peri-Implant Plastic Surgical Approaches to Increasing Keratinized Mucosa Width: Which to Use and When?

The long-term efficacy of adequate keratinized mucosa (>2 mm) in dental implants is controversial. Peri-implant plastic surgeries are currently used because they increase keratinized mucosa width (KMW), helping to regain peri-implant health and maintaining it over the long-term. We present the clinical findings using free-gingival-graft (FGG) and free-periosteal-graft (FPG) techniques in peri-implant plastic surgery for implant rehabilitation patients. We included 20 patients with implant indications of inadequate KMW (KMW < 2 mm for postimplantation) in the maxilla and mandible. All underwent clinical and radiographic measurements and a treatment protocol was prepared for implant rehabilitation and subsequent peri-implant plastic surgery. A decision as to whether and when FGG or FPG techniques would be used was made. FGG/FPG was performed pre-implantation (before monocortical block-bone augmentation) or postimplantation (before/during/after stage 2 surgery). KMW was ≥ 2 mm after application of FGG/FPG pre- or post-implantation. Moreover, peri-implant tissue health was regained/maintained in all cases from 6 months to 4 years. Peri-implant plastic surgery techniques can prevent hard- and soft-tissue problems after implant rehabilitation and during treatment of developing problems. However, surgical design and timing, and an interdisciplinary perspective determine the success of peri-implant plastic surgery.

A combined peri-implant plastic surgery approach for implants in the esthetic zone using a novel technique: A series of 10 cases

OBJECTIVE In this study, 12-month follow-up clinical results of a combined peri-implant plastic surgery approach for hard and soft tissue augmentation in implant rehabilitation in the esthetic zone are presented. METHOD AND MATERIALS Ten individuals who required extraction due to severe periodontal destruction in the maxillary and mandibular area were included in the study. Implant surgery was performed in the same session as the combined peri-implant plastic surgeries, which involved guided bone regeneration and free periosteal grafts. Prosthetic treatment was administered in the sixth month following the surgeries. RESULTS Hard and soft tissue augmentation with sufficient keratinized mucosa width (≥ 2 mm) was achieved with the combined surgical approaches. Pleasing esthetic results were obtained by careful positioning of the implants. CONCLUSIONS In implant rehabilitation, in cases where there are insufficient hard and soft tissues in the esthetic zone, a combined peri-implant plastic surgery approach not only enables the ideal implant position where both function and esthetics are ensured but also provides effective protection of peri-implant tissue health.

RECURRENT ODONTOGENIC MYXOMA OF MANDIBLE: A CASE REPORT

Odontogenic myxoma is known as a rare benign mesenchymal odontogenic neoplasm in oral cavity. Tumor is seen most frequently in mandible. Because asymptomatic, the tumors usually discovered during a routine radiographic examination. Large lesions can be diagnosed easily due to the jaw expansion and perforation of the cortical plate. Radiologically, the lesion can be seen unilocular radiolucency or multicystic lesion with well-defined or diffused margins. The radiographic appearance can be defined as “honey coumbed,” “soap bubble,” or “tennis racket”

Combined Soft and Hard Tissue Peri-Implant Plastic Surgery Techniques to Enhance Implant Rehabilitation: A Case Report

This case report presents an implant-aided prosthetic treatment in which peri-implant plastic surgery techniques were applied in combination to satisfactorily attain functional aesthetic expectations. Peri-implant plastic surgery enables the successful reconstruction and restoration of the balance between soft and hard tissues and allows the option of implant-aided fixed prosthetic rehabilitation.